Pathological Changes of Optic Nerve

Eyeball
By Shandong Science And Technology Press (1985)

The common pathological changes of optic nerve are atrophy of optic nerve and optic neuritis, which includes papillitis, and retrobular optic neuritis.Those above diseases may be infected from the foci such as tonsillitis, parasinusitis, caries teeth, virus, or tuberculosis. They may also be spread from retinitis, choroiditis etc.

Atrophy of optic nerve may be either primary or secondary in nature. The primary optic atrophy caused usually by surgical trauma, bony fracture, intracraninal compression, or intoxication due to methyl alcohol, quinine or lead. The secondary optic atrophy is commonly seen in case of papilitis, papilar edema or in the late stage of glaucoma.

Symptoms and Signs:

1 Retrobulbar optic neuritis: impairment of vision, pain of eyeball (may be excited with movements of the eyeball), central scotoma, and contraction of visual field.

2 Papillitis: usually unilateral in nature, vision markedly reduced at the beginning of disease, contraction of visual field, and central scotoma and frequently associated.

3 Optic atrophy: the primary symptoms are diminution of visual acuity, even blind, contraction of visual field and color blindness.

Treatment:

Remedy 1

A Points:  Three groups of points may be adapted.
Group 1: Jingming, Qimai, Yangbai, Yiming, Ganshu, and Gukong.
Group 2: Qiuhou, Taiyang, Fengchi, Shenshu, and Guangming.
Group 3: Chengqi, Geshu, Sizhukong, and Xingjian

B Procedure: Jingming, Yangbai, Yiming, Qiuhou, Taiyang, Fengchi, Guangming, Xingjian same as for acute conjunctivitis and pathological changes of retina.

Qi Mai is penetrated along the skin surface 0.3 ~ 0.6 inch and scrap the needle.

Ganshu and Geshu are penetrated with needle in 300 angle and obliquely downward 0.8 ~ 1.2 inch. Twirl the needle at the same time.

In puncturing Shenshu, needle is inserted in 300 angle with the manipulation of twirling.

For Sizhukong, needle is inserted upward and along the border of orbit with depth of 0.3 ~ 0.5 inch.

Moxibustion performed on Gukong with putting the cone on a piece of ginger (0.1 ~ 0.17 inch in thick). Three to five cones for one therapy will be enough.

To the point Chengqi, penetrate perpendicularly and slowly with depth of 0.5 ~ 1.5 inch and acrape the needle. For preventing intraorbital bleeding due to trauma of blood vessel, twirling and twisting are contra indicated and if it appears, compress the eyeball with cotton sponge 3 ~ 5 minutes.

It is a rule, puncture Shu points in dorsal aspect of the trunk first, and the retaining of needle is usually short. Other points are penetrated afterward with retaining of the needle 30 ~ 60 minutes and manipulate the needle once every 10 ~ 20 minutes.

Treatment is given once daily. Every 5 treatments are a course of therapy. The interval between courses is 1 ~ 2 days.

Following Chinese medicinal herb and pills should be given at the same time:

  • A Herb broth:
  • Rhizoma Rehmanniae Praeparatae
  • Fructus Lycii
  • Radix Polygoni Multiflori
  • Fructus Ligustri Lucidi
  • Radix Salriae Miltiorrhizae
  • Radix Angelicae Sinesis
  • Radix Bupleuri
  • Semen Cassiae
  • Concha Haliotidis
  • Rhizoma Atractylodis Macrocephalae
  • Herba Dendrobii
  • Radix Ledebouriellae

In treating the pathological change of optic nerve with herb, to nourish Yin and to supplement kidney is the primary principal. Other drugs may be used for dispersing the depressed liver-energy and depressive syndrome, eliminating the phlegm and clearing away the wind-heat.

Given by decoction in water for oral dose Q.D.

B Pills: Sheep liver pills (according to prescription given in “Golden Mirror for Original Medicine”

C Case example:

April 27, 1965, O.P.D. patient Zhu, female, 60 years old, a farmer. Diminution of vision occurred for 2 years suggesting hyperopia. Symptom increased in recent 5 months, only light perception still present.

Patient was examined in a hospital and represented that external occurs normal, margin of papillae became blurring and pale, central fovea diminished, narrowing of retinal artery. The diagnosis was optic atrophy.

Physical examination in author’s O.P.D. revealed pale fur, pulse sinking and weak in its proximal portion.

Thirst, pain of back and insomnia are complained.

Patient was treated in author’s O.P.D. with acupuncture and Chinese traditional medicine. Among which, Chinese traditional medicines are used for nourishing Yin and kidney, relaxing the liver and improving the blood circulation.

Sheep liver pills were also given.

Above groups of points adapted alternately for each course of therapy. Patient was treated for 3 months as above.

Seventy herb broth taken totally, after treatments described above, patient’s visual acuity recovered to 0.3 O.S.; 0.2 O.D. Since then, patient can take care of herself and attend to homework.

Remedy 2

(A) Points: There are seven groups of points to be selected.
Group 1: Fengfu, Fengchi, and Taiyang
Group 2: Shangxing, Muchuang, and Yingxiang
Group 3: Binao, Hegu, and Guangming
Group 4: Zhaohai, Hegu, and Zanzhu
Group 5: Yuyao, Sibai, and Shenmai
Group 6: Jingming, Tongziliao, and Head-Linqi
Group 7: Mingmen and Ganshu

(B) Procedure: One group of points adapted alternately by 1 day.

Each therapeutic course consisted of 7 days. Twirl and scrape the needle in case of Ganshu and Mingmen quickly.

In other points besides Ganshu and Mingmen, manipulate the needle once every 5 ~ 10 minutes and retain the needle 15 ~ 30 minutes.

Fengchi is penetrated perpendicularly with slow insertion and 0.3 ~ 0.5 inch deep, scraping the needle gently. In order to avoid injury of medulla, deep penetration is contraindicated.

In point of Muchuang, push the needle forward horizontally 0.3 ~ 0.5 inch and manipulate the needle by twirling and scraping.

Needle penetrating Binao is directed upward 450 angle and 0.8 ~ 1 inch and that puncturing Zhaohai is directed perpendicularly with 0.3 ~ 0.5 inch in deep. The needles penetrating above two points are manipulated with twirling.

Zanzhu is penetrated toward Yuyao and Shenmai is punctured perpendicularly 0.3 ~ 0.5 inch.

Head-Linqi is penetrated forward horizontally with 0.3 ~ 0.5 inch deep.

Manipulate the needle with scraping and twirling for Head-Linqi, Shenmai and Zanzhu.

There were 21 cases of retrabulbar optic neuritis treated with the method mentioned above in Congqing hospital of TCM, among them, 7 cases were cured.

Remarks:

Pathological changes of optic nerve belong to the class of “Qing Bao” and “Shi Zhan Hun Miao” in Chinese traditional medicine. In the ancient medical book “Comprehensive collection on Medicine” considered: “Patients lose their visual acuity without any abnormality in the appearance of the eye.”

The cause of this disease usually suggests as the deficit of liver and loses of seven modes of emotions. Kidney is the water storage and is also the congenital essential substance. If the kidney loses its function congenitally, the wood could not be nourished.

The eye is the orifice to live. Once wood is malnourished, the liver blood becomes deficient and can not flow upward to the eye. Ancient Chinese medical book “The Canon of Internal medicine” described: “Visual acuity only presents when blood is gotten and blindness occurs when blood is lost”.

Therefore, in treating eye disease, strengthening Yin and restoring kidney are the essential principle. Because kidney is essential to liver, the liver may be nourished after kidney restored and visual acuity recovered spontaneously after liver wood has been nourished.

However, the disease is not so simple. The deficiency of kidney may be in some time associated with wind-heat, wetness-phlegm, and depression of liver-energy. Therefore, selection of point in acupuncture and prescription in medication would be nimble with adaptability.

Experiences about acupuncture therapy for eye diseases have been reported. There are three aspects in selecting points:

1 Select the points in local region or near the eye, e.g. Jingming, Qiuhou, Chengqi, Sizhukong, Yangbai, Taiyang etc.

2 Points along the channels, e.g. Shenmai, Guangming, Fengchi, Qimai etc.

3 Points various with symptoms, e.g. Zhaohai, Shenshu, Ganshu, and Geshu.

Thus, the eye disease is treated both locally and generally. If the primary cause and secondary cause are treated at the same time, good effect will be obtained therefore.

The pathological changes of the eye are a kind of degenerative disease, it is necessary to treat for long time. Groups of points may be adapted alternately, for elevating its sensitivity and the therapeutic effect.

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